How often does this happen to you? You are awakened from a sound sleep by the unmistakable sound of your cat about to cough up a furball on the comforter next to you. If you are lucky, you will be able to move kitty safely to the floor or be resigned to washing the comforter again! Many cat owners think that vomiting hairballs is normal behavior in a cat. But that is not always true. For example, one of my patients is Francis, a 14 year old handsome red and white tabby, who was diagnosed with diabetes several years ago. Up until last year Francis flourished, his weight went back to normal, his appetite was consistently good, and his litter box habits were regular. Then 6 months ago, Francis came in with a few days history of decreased appetite and vomiting. His physical exam was normal; his basic blood tests and urinalysis were normal. A few days later Francis vomited a furball. His owner was happy figuring this was the reason for the symptoms. Over time his weight began to decrease, and he intermittently repeated his pattern of exhibiting a poor appetite and then a few days later vomiting a furball. Additional blood tests and an abdominal ultrasound indicated the possibility of pancreatitis and/ or inflammatory bowel disease as the cause(s) of his symptoms. For now, we are keeping a close eye on Francis. If his condition changes, we will discuss confirming this diagnosis by biopsy and possibly diet changes and medication to treat those diseases.

To his owner, Francis was just having furball trouble. To his doctor, Francis’ furball vomiting was an indication of an underlying problem. Why was I suspicious? A review of Francis’s history indicated that he was vomiting furballs much more frequently than he had in the past. Vomiting furballs more often, particularly in a middle aged or older cat – even as the only change in a cat’s behavior; can be an indication that something is amiss. Either Francis was ingesting more fur because of increased grooming activity – meaning itchy skin (see recent post), or there was a change in the way food was moving through his upper digestive system. There are multiple reasons why this might have happened. Chronic inflammatory disease is the most common explanation. Pain or hormonal changes can also result in alterations in intestinal movement. Just as with Francis, a visit to your veterinarian is a good place to start to rule out an underlying problem.

A few months ago Francis’ owner told me, “ You were right doctor”. What he meant was that he had been skeptical when I had expressed my initial concerns that Francis’ vomiting reflected more than just furballs. Francis’ owner is a loyal reader of this blog. When he was in the other day, he suggested that I write about furballs. He had overheard a comment between cat owners that furball vomiting was routine ( i.e. normal). He now knows that it isn’t necessarily so. He asked that I write about furballs to educate other cat owners about this situation. I am happy to oblige.

Dr. Kathleen Keefe Ternes grew up in western Massachusetts. She received an undergraduate degree from Cornell University in 1974; a BS degree in 1978 and a DVM in 1979 from Michigan State University. Dr. Keefe Ternes returned home to New England in April 1980. In 1984, she achieved one of her professional goals by opening The Feline Hospital in Salem, MA. . Dr. Keefe Ternes, a diplomate of the American Board of Veterinary Practitioners (ABVP), initially certified as a companion animal specialist in 1990. She became certified as a feline specialist in 2000 and recertified in 2010. Dr. Keefe Ternes is a member of AAFP, the AVMA, the MVMA, and her local organization, the Veterinary Association of the North Shore (VANS). Her involvement in organized medicine includes having been a past president of VANS and current member of the board of directors. She is also a case reviewer for the ABVP and recently joined the Feline Welfare Committee of the AAFP.

Dr. Keefe Ternes lives in Salem with her husband and two college age daughters. Her two senior cats Toby and Petunia keep her on her toes medically.

I wrote last time about the choice my client Louis had to make to end the life of his beloved cat, Nadia. It is always a struggle for the owner and his/her veterinarian to make these decisions. Worse, of course, for the client because of the years of love and companionship that have transpired. The strongest desire of the cat owner facing the loss of a beloved companion is to do what is best for the kitty. Sometimes, the outcome that seems the least likely though, can mean a new reality for a cat and his owner. Let’s talk this time about Garfield.

Garfield, no surprise, is an orange tabby about 15 years old. He came in 6 months ago, just not feeling right. His bloodwork and urinalysis were not completely normal and it was obvious that he had severe pancreatitis. We started his treatment for that and he got somewhat better but just not quite back to normal. Perhaps we had not gotten to the bottom of the problem!

We did another ultrasound and, no surprise, his pancreas looked abnormal but everything was otherwise fine. A few days later and quite suddenly, Garfield took a turn for the worse. This time his bloodwork was far less normal; the white part of his eyes looked a tiny bit yellow; and, his ultrasound showed a large blocked gall bladder and a little fluid around his liver. The findings had changed a great deal in a very short time.

We contacted our favorite surgeon, one that I had been very happy with for many years. That afternoon, Garfield went to Dr. Griffin’s practice, 100 miles away. The next day, he had a complicated surgery to connect his gall bladder to his small intestine to allow his pancreas to heal and give his gall bladder a safe way to empty. A tube was placed in his esophagus to allow for adequate nutrition and administration of medicine. He came home with antibiotics, pain medication, liver supportive medication and more. We worked with the client to make sure he received adequate calories through the tube and got all of his medications.

As each day went by, Garfield got a little bit better. He began to gain weight and started to eat a little on his own. After three weeks, he was eating enough on his own that we removed the tube in his esophagus. We monitored him carefully for several months, both by examination and laboratory values. He is doing just fine.

The message of Garfield for me is that, even when things look complicated and very, very serious, good things can and do happen. We all need to stay optimistic and realistic, making sure not to allow for suffering or discomfort. If we maintain Quality of Life during a severe illness, we can be proud of our work together. The owner is the single most important member of the healthcare team. We are here to help make sure that is always true.

Dr Colleran attained both her Masters (in Animals and Public Policy) and Doctorate from Tufts University School of Veterinary Medicine. She opened Chico Hospital for Cats in 1998 and the Cat Hospital of Portland in 2003. In 2011, she became President of the American Association of Feline Practitioners.

Diarrhea is defined as the passing of soft or watery stool (feces). It can be caused by many things including stress, bacteria, viruses, diet, toxins, immune mediated disorders, drugs, and even conditions not directly related to the gastrointestinal tract such as pancreatitis, hyperthyroidism, or adrenal gland disease.

Diarrhea can be acute (sudden onset- lasting a few days to a week) or chronic (lasting more than a few weeks or intermittently over several weeks to months). Frequent small amounts of feces with blood or mucous present are seen with disease in the colon. Larger amounts of feces passed once or twice a day is typical of small intestinal disease. Cats with small intestinal disease often times have weight loss associated with their diarrhea.

Testing for diseases that cause diarrhea can include fecal tests, blood work, and sometimes even radiographs, ultrasound, or biopsy for more chronic cases. Treatment will depend on the cause of the diarrhea.

Since some bacteria and parasites can be transmitted from your cat to you and your family a routine fecal check and de-worming should be performed yearly in accordance with the recommendations from the Center for Disease Control.

If your cat has a bout of diarrhea, seems otherwise healthy and playful, and is current on his/her health care you do not need to be alarmed, but should monitor more closely when scooping the box and make sure that he/she is eating and drinking. If the diarrhea is persisting or your kitty is not eating or drinking well or seems more lethargic, you should call your veterinarian.

Dr. McManis is an avid triathlete and is constantly training for races. She completed her first Iron Man in May of 2012. She is owned by 2 home kitties- Amante (“Monty”) and La Mariquita (“Mari”), and 2 hospital kitties- Momma Kitty and O’Malley.